Sarasota doctor performs historic carotid artery surgery

Dr. Russell Samson, wearing a sharply-tailored blue suit, calmly walked into a room at Sarasota Memorial Hospital last Thursday where journalists were waiting to interview him about something historic he had done at the hospital.

On Dec. 21, Samson, a vascular surgeon whose practice is Sarasota Vascular Specialists on Cattleman Road, became the second of only two doctors in Florida and the first locally to perform a brand new minimally invasive outpatient procedure designed to clear severe deposits of plaque from the carotid artery for patients at high-risk for traditional treatments.

The procedure is called TransCarotid Artery Revascularization, or TCAR for short.

What makes TCAR unique, said Samson, is that it doesn’t involve cutting into the neck artery to remove the plaque or putting a stent through the groin and up to the neck to remedy the obstruction, both of which carry dangers for stroke or heart attack if a bit of plaque gets loose, Samson said.

TCAR, which has one very Hollywood-ish feature, namely a circuit outside the body that temporarily reverses blood flow away from the patient’s brain during surgery, was developed by a start-up company called Silk Road Medical, Inc. in Sunnyvale, Calif.

Medicare will cover the TCAR procedure only for patients deemed high risk for adverse outcomes from the open surgery or or stents through the groin, Samson said.

Sarasota Memorial Hospital is among the first Florida hospitals to do the procedure.

One would have expected Samson to look and talk like a mad scientist since the whole idea of reversing blood flow inside the brain, even temporarily, seems implausible, like a scientist trying to reverse the planet’s magnetic field.

But the 66-year-old Samson, who grew up in South Africa, actually looks and talks more like an trim athlete, a curled up coil wearing a suit. He is 150 pounds of wiry muscle, seemingly capable of delivering a precise karate-chop to a stubborn blood vessel in the blink of an eye.

Bradenton woman is first patient

On Samson’s operating table for the historic surgery was 67-year-old Elizabeth Johnson, a Bradenton woman who had severe blockage in both her carotid arteries and was considered too high risk for the two other standard carotid procedures.

Johnson had had surgery 15 years ago to remove plaque from clogged arteries on both sides of her neck. She recently found out that scar tissue was blocking her carotid arteries again.

“I had the open surgery in the past,” Johnson said, speaking of carotid endarterectomy. “I had an incision up the whole side of my neck. There was a risk that I could lose my speech and that my tongue would go numb. After the surgery, there were a lot of things I couldn’t do. I couldn’t bend and I couldn’t drive.”

“I was lucky I was able to have this new procedure,” Johnson added. “The whole experience was a lot different, and so much better. The incision was very small and I was able to go home the next day and get back to my normal routine right away.”

How TCAR works

A soft, flexible sheath is placed directly into the carotid artery via a small incision near the collarbone.

The sheath is connected to a circuit that will reverse the flow of blood away from the brain to protect against fragments of plaque that may come loose during the procedure.

The blood is filtered for bits of dangerous debris through the sheath and returned through a second sheath placed in the femoral vein in the patient’s thigh.

While the flow of blood is reversed the surgeon can do balloon angioplasty and stenting.

After the stent is placed successfully to stabilize the plaque in the carotid artery, flow reversal is turned off and blood flow to the brain resumes in its normal direction.

The wildest part of the procedure — the reversal of blood flow to the brain — can occur because the connection between the arterial system’s high pressure in the brain and low pressure in the thigh create a pressure gradient that causes the blood to move backwards in the carotid artery.

“Amazing,” Samson said of the procedure. “It’s so simple, really, which the best procedures are. I was so excited. I was especially excited when I saw what came out of that woman’s neck and knowing what would have happened had we done a standard stent. I think this lady would have had a stroke.”

The surgery took about an hour and Johnson was well enough to go home two hours later, but the hospital kept her overnight just to make sure she was fine.

Information: 941-371-6565 or visit Sarasota Vascular Specialists, 600 N. Cattleman Road, Suite 22, Sarasota.

This story was originally published January 30, 2017 at 5:44 PM with the headline "Sarasota doctor performs historic carotid artery surgery."